Welcome to Dr. James Wilson's Adrenal Fatigue Blog

Is Taking Cortisol a Safe Way to Treat Adrenal Fatigue?

letter QIs Isocort a safe way to treat my adrenal fatigue? I have been self-treating for over a year now, and I get ahead and then life issues, (surgery, stress, job stress) kick me back down. I have not wanted to treat with any kind of cortisol for fear of making my adrenals shut down, but I don’t feel that I am getting anywhere with supplements. I am on Dr. Wilson’s tincture of ashwagandha, Siberian ginseng, maca and licorice right now. I think I am allergic to one of the ingredients because I had an itchy rash while taking it, and when I went off, it went away. I would appreciate any suggestions on safely treating with Isocort, or other form of cortisol. 

letter AThere are some cases in which giving cortisol temporarily and then weaning off of it appropriately may help adrenal fatigue if given in conjunction with supplements which support your body’s stress response system. It is important to note this should be done under the watchful care of a healthcare professional. However, I do not recommend using cortisol alone (either plant based or synthetic), and I recommend extreme caution in using it at all, especially if you are not under the care and supervision of a medical professional.

thermostat by Flickr user super-structureThe body has a very complex system of checks and balances to maintain appropriate hormone levels. One way it does this is through a signaling process called negative feedback. Negative feedback occurs when an optimal level of hormone is reached and the hormone “feeds back” this information to the brain to turn off production. It works sort of like a thermostat that turns off the heater once a certain temperature is reached. If you take hormones, they can send this negative feedback signal to turn off the body’s own production and can eventually shut down the glands’ ability to produce hormone at all. (This is why men’s testes can shrink when they take anabolic steroids).

Taking cortisol may increase your energy and make you feel better in the short term, but that doesn’t mean that it is helping your body heal. (Many people feel better and more energized taking amphetamines, but I don’t think that provides a good medical rationale to take speed.) Taking cortisol alone does nothing to support the adrenal glands to make their own cortisol or to heal. A healthier approach is to give the adrenals the building blocks they need to regenerate, the nutrients they need to synthesize hormones, herbs to help support the body during stress, and antioxidants to protect the adrenals from damage as they produce the hormones. The herbal tincture you mentioned does one part of that (helping the body adapt to stress). You may be able to find the herbs individually and eliminate the one that is causing your problems.

In treating adrenal fatigue, I recommend a complete lifestyle and treatment approach: eliminating sources of stress and learning healthy ways of dealing with it, eating regular nutrient dense meals to prevent blood sugar fluctuations, getting sufficient rest and moderate exercise, and nutritionally supporting the body and the adrenals in their recovery rather than simply taking a hormone which could make you feel better temporarily but has the potential to create more problems in the future.

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

Image credit: Thermostat by Flickr user super-structure

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Why Does Adrenal Fatigue Give Me a Racing Feeling?

Q: My cortisol levels are finally normal after several years of being quite low. However, it’s taking my body much longer to regain strength and i still “race” inside all the time. What exactly is going on physiologically when i race? It increases with stress, being overtired and food reactions?

A: To answer your question I need to explain a little bit about the anatomy and physiology of the adrenal glands. The adrenals are two small glands that secrete a large number of hormones, most of which are designed to help the body meet the demands of stress in one way or another. Stress is a broad term and may be mental or physical, including such things as illness, food sensitivities, extreme physical exertion, being overly tired or overly hungry, or feeling emotionally “stressed out.”

racing terriers by Flickr user garryknight

Does adrenal fatigue and stress give you that racing feeling?

The adrenal glands have two primary layers: an outer layer, called the cortex; and an inner layer, the medulla. Each layer is responsible for secreting different hormones. Cortisol, the primary hormone responsible for the body’s stress response, is one of the hormones secreted by the cortex. Adrenal fatigue is characterized by the inability to secrete enough cortisol to meet demand when the body is under stress.

The medulla, or inner portion of the adrenal glands, secretes other hormones, including epinephrine and norepinephrine (also called adrenaline and noradrenaline). These are secreted under stress as well and help create the familiar “fight or flight” response in which heart rate increases, airways open, and blood is shunted to skeletal muscles.

If a person has adrenal fatigue and cannot secrete sufficient cortisol levels under stress (which can occur even after cortisol levels have returned to normal levels at rest), the body will still secrete more epinephrine and norepinephrine (sometimes in even greater quantities), inducing the familiar racing heart and associated symptoms.

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

Image credit: Racing terriers by Flickr user garryknight

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Using Glandular Extracts for Stress and Adrenal Fatigue

fatigued adrenal glandsI saw early in my clinical work that most people suffering from adrenal fatigue need more than just lifestyle changes and alterations in their food intake. Normally, good quality food is the best source of these nutrients, but once depleted, the adrenals need more than diet alone is likely to provide. I found, clinically, that supplementing with specific concentrated nutrients markedly increased my patients’ ability to strengthen adrenal function and recover their health.

I began using adrenal extracts with my patients with adrenal fatigue and found that they slowly improved over time, but their progress was too slow for my liking, no matter which adrenal concentrate they took. However, by combining concentrated, hormone-free extracts of the glands most involved in the stress response, we were able to achieve much better outcomes than we had using them singly. I started adding specific nutrients one at a time, and through trial and error discovered that most people suffering from adrenal fatigue and similar stress related health problems need much more of some nutrients than others. As nutrient after nutrient was added, people began responding and recovering more and more quickly, and then recovering more fully. Over time, it became apparent that most people with adrenal fatigue need the same nutrients, only varying in quantity depending upon severity. The more severe the adrenal fatigue, the more of these specific nutrients they needed to sustain themselves, function well and recover fully. The glandular extracts work so deeply that it usually takes several weeks, or even months, to notice their effects, but these effects are profound and form the foundation for lasting results.

All of our glandular extracts come from natural-feed pigs. Obtaining these extracts from a porcine (pig) rather than bovine (cow) source eliminates concerns about prions or BSE (mad cow disease) because there are no known porcine sources of prions. The glandulars come directly from animals inspected by independent veterinarians and raised for food consumption without chemicals, antibiotics, growth hormones, pellet food, forced feeding, overcrowding, or any of the other inhumane methods often associated with commercial animal husbandry. The glandular tissues used in Adrenal Rebuilder have been processed to remove the hormones and steroids (a type of adrenal hormone) that may be naturally present in these glands. This formula provides natural building blocks that support optimal adrenal function so that the adrenal glands themselves can produce healthy amounts of the adrenal hormones as needed.

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Is Adrenal Fatigue Hereditary and Adrenal Fatigue & Irregular Heartbeat

Q. Can adrenal fatigue or stress cause an irregular heartbeat? Can it be fixed?

heart on stone by Flickr user epSos.de

Image credit: Flickr user epSos.de

Both stress and adrenal fatigue can cause irregular heartbeats, also known as arrhythmia. Stress can often cause tachycardia, or a faster than normal rhythm over 100 beats per minute. Adrenal fatigue can lead to high potassium and low sodium levels, which can interfere with the electrical signals that regulate heart rate.

If the irregular heartbeat is due to stress or adrenal fatigue, it can be corrected by reducing the stress or treating the adrenals and balancing electrolyte levels. However, there are many causes of arrhythmia including heart disease, thyroid problems, or taking certain drugs or cold medications. It is important to determine what is causing the arrhythmia and treat accordingly.

Q.  Is adrenal fatigue hereditary? If you suspect it in your teen daughter, should you get it checked? One of my doctors says it can be checked through bloodwork. Is that true? I have only had mine checked through saliva testing.

Adrenal fatigue is not hereditary, per se, but both genetics and environment can influence cortisol reactivity to stress. Yes, if you suspect adrenal fatigue in your daughter, test for it. Cortisol can be tested in the blood, but almost all serum (blood) cortisol is bound to protein. The body can’t use bound hormones. I prefer salivary levels because they represent “free” or unbound cortisol, the form that is actually available for use in the tissues. Also, cortisol levels change significantly throughout the day. Salivary tests make it easy to test cortisol levels four or more times in one day and determine the cortisol’s daily pattern.

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

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Adrenal Fatigue & Vision and How Long Does it Take to Recover from Adrenal Fatigue?

Question: What impact can adrenal fatigue have on vision? Is there a connection between adrenal fatigue and cataracts?

eye closeup by Flickr user Gregoire Lannoy

Image credit: Flickr user Gregoire Lannoy

The adrenal hormone cortisol is the body’s best anti-inflammatory. Because cortisol is low in adrenal fatigue, inflammatory eye conditions such as iritis, uveitis, and dry eyes can worsen with adrenal fatigue. Cataracts aren’t directly related to adrenal fatigue, but some people with lowered adrenal function or inflammatory conditions are prescribed glucocorticoids—synthetic drugs such as prednisone that mimic cortisol. These drugs can cause a particular type of cataract, a steroid cataract. In addition, these synthetic steroids have the possibility of increasing pressure in the eye which could predispose someone towards glaucoma.

Question: I’ve been off and on the protocol for a couple of years. When I stop it, I notice that the fatigue comes back, although not nearly as severe as it was years ago. Will I need to be on this for the rest of my life? Can I recover fully? Does the amount of time it takes to recover depend on the severity of the adrenal fatigue and how long it went untreated?

Good question: One of the biggest problems I encountered in my practice while working with patients with adrenal fatigue is that as they started to feel better, they would think that the supplements were no longer necessary. They would try and discontinue them too soon and then would be back in my office with the same problems as before. People vary in the time it takes their bodies to recover. Often, someone begins to feel better within a few weeks or months, but typically, it takes someone about 6-9 months to fully recover from mild adrenal fatigue, 12-18 months for moderate adrenal fatigue, and sometimes it can take 2 years or more to fully recover from severe adrenal fatigue. If you continue to be under extreme stress, you may need to support your body for a longer period of time. However, barring an extreme circumstance, you should not need to be on supplements that support your adrenals for the rest of your life.

Recovering from adrenal fatigue takes time, but it is possible. Good luck!

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

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The Adrenal & Thyroid Relationship and Mouth Infection & Adrenal Fatigue

Question: How much work do the thyroid and adrenal glands share, and how do they hand off their responsibilities?

The thyroid and the adrenal glands have different responsibilities, and don’t exactly “hand off” tasks, but they work closely together in the body. The thyroid has many functions, but is primarily concerned with controlling metabolism and calcium balance in the body. The adrenal glands secrete a large number of hormones, including stress hormones, sex hormones, and hormones which act to conserve sodium and increase blood pressure.

diagram of endocrine system male and femaleThere are numerous ways that the glands and their hormones impact one another. Because thyroid controls metabolism and how efficiently the body uses energy, it affects every other system and organ in the body. The adrenal glands impact the thyroid too. Rising levels of cortisol (a stress hormone produced by the adrenals) can decrease the production of thyroid stimulating hormone, thus decreasing thyroid hormone production. High levels of cortisol can also cause thyroid hormone to be converted to a weaker form, creating low thyroid symptoms.

Because of their relationship, both low adrenal function and low thyroid function can create fatigue, sluggishness, lowered sex drive, and depression.

Question: Do you think chronic infection from faulty root canals or general poor mouth health can be a contributing factor for developing adrenal fatigue?

Chronic infection or poor mouth health can absolutely be a contributing factor to the development of adrenal fatigue. The adrenals are the glands of stress, and so recovery from illness and infection—both of which are significant stressors—involves the adrenals. One of the primary functions of the adrenal hormone cortisol is to reduce inflammation. (This is why synthetic drugs that mimic cortisol are frequently prescribed for conditions with an inflammatory component.)

teeth by Flickr user Ewan BellamyIf you are harboring a chronic infection, your adrenals will continue to produce cortisol to try and limit excessive inflammation. The teeth and gums are common locations for this type of sub-acute chronic infection. If you have adrenal fatigue and are incorporating the dietary and lifestyle changes recommended in Adrenal Fatigue: the 21st Century Stress Syndrome and are using the recommended nutritional supplements but are not getting better, an underlying body burden such as chronic infection is likely. Work with a physician to try and identify the underlying cause. Sometimes laboratory tests showing changes in the white blood cell count (the immune cells responsible for fighting infections), an elevated sedimentation rate or high-sensitivity C reactive protein (markers of inflammation), or a low albumin (suggesting chronic disease) can be indicators of chronic infection or inflammation. There are other body burdens which can also tax the adrenals such as an imbalance in intestinal bacteria, the presence of food sensitivities, or chronic exposure to toxic chemicals, but sub-acute chronic infection is a commonly overlooked body burden and adrenal stressor.

Image Credits: Endocrine diagram via Wikimedia Commons; tooth photo by Flickr user Ewan Bellamy

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

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How to Diagnose and Help Adrenal Fatigue

How do doctors diagnose adrenal fatigue?

saliva-testMedicine generally only recognizes Addison’s disease, which is the most extreme end of low adrenal function. Doctors who are familiar with the varying degrees of decreased adrenal function usually test the adrenal hormone levels in your saliva. This is an accurate and useful indicator of adrenal fatigue that is simple and relatively inexpensive. A test kit can be obtained from the lab and the test completed at home by simply spitting into the test tubes 4 times throughout a 24 hour day and filling out an activity sheet to go with the saliva samples. There are other common lab tests that can be used more indirectly to detect adrenal fatigue if the practitioner knows how to interpret them. So if you suspect you are experiencing adrenal fatigue, seek out a healthcare practitioner who is familiar with this problem.

What helps someone with adrenal fatigue?

For most people, a focused program of lifestyle modifications, body-mind practices, specific nutrients and targeted supplementation for adrenal support can help revitalize adrenal function and greatly enhance stress hardiness. In adrenal fatigue, hormone therapy with corticosteroids is usually not necessary or desirable. In fact, taking adrenal steroid hormones suppresses adrenal function and can exacerbate adrenal fatigue. This situation differs from Addison’s disease in which the adrenals are incapable of producing adequate adrenal hormones and an external source is required for continued survival. With adrenal fatigue, the adrenals are still functioning and are capable of returning to optimum with proper support.

What keeps the adrenal glands healthy?

coffee by Flickr user dyobmitThe guidelines for keeping your adrenal glands healthy are very similar to the overall principles of good health but there are a few factors especially important for adrenal support and building stress resilience: Eat regular meals with good quality food that combines balanced amounts of protein, healthy fats and complex carbohydrates at every meal and snack – including breakfast; avoid sugar and stimulants like caffeine (even though it temporarily makes you feel better, it only depletes your adrenals more); exercise moderately; get adequate rest (go to bed by 9:30 PM and sleep in as long as you can in the morning); learn to manage your stressors. Because modern life is so stressful, nutritional supplements designed specifically for adrenal support may also be a great help.

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What is Adrenal Fatigue?

What is adrenal fatigue?

Your adrenal glands respond to every internal and external stress you experience by preparing your body to react to the stressor while maintaining your life-preserving homeostasis. They do this via the various hormones they produce, the primary one being cortisol. In adrenal fatigue the adrenal glands function, but below their optimal level. As a result, adrenal hormone output and the body’s ability to cope with stress are also diminished. Adrenal fatigue is different from Addison’s disease, which is the relatively rare extreme of low adrenal function primarily caused by damage to the adrenal glands from disease. Adrenal fatigue is not a disease and is usually associated with intense or prolonged stress. In these stressful times adrenal fatigue is so common that it is fatigued adrenal glandsestimated to affect most people at some time in their lives. Adrenal fatigue can be mild and transient, but millions of people are currently struggling with a cycle of diminished adrenal function and inescapable stress that can have considerable negative consequences for quality of life and overall health.

What does adrenal fatigue feel like?

As the name suggests, its main symptom is fatigue. This fatigue is not relieved by sleep and has a distinctive pattern that sets it apart from fatigue caused by other health or lifestyle factors. Its pattern primarily reflects the lowered daily fluctuations of cortisol that result from the reduced capacity of the adrenal glands to produce adrenal hormones. In adrenal fatigue, cortisol (which is normally highest at around 8 AM) is low in the morning making it harder for you to wake up and get going, even if you have had a full night’s sleep. The following are common to people experiencing adrenal fatigue:

stressed faded manDifficulty getting up in the morning
• Not fully awake until after 10 AM
• Needs caffeine to get going
• Energy low from mid to late afternoon
• Better energy after 6 PM until around 9 PM
• Second wind from around 11 PM to 1 AM
• Snacks on salty or sweet foods and caffeine to keep going
• Feels run down
• Harder to bounce back from illness or other stresses
• Difficulty concentrating and thinking clearly
• Lower libido
• Poor sleep
• Sick more often
• Increased symptoms with allergies, PMS or menopause

What causes adrenal fatigue?

Adrenal fatigue is produced when the output of regulatory adrenal hormones is diminished through over-stimulation of the adrenals by severe, chronic or repeated stress, or because of adrenals weakened by poor nutrition, congenital factors or other influences. The causes of adrenal fatigue usually stem from one of four common sources that overwhelm the adrenal glands:

1. Disease states such as severe or recurrent pneumonia, bronchitis or flu, cancer, AIDS, auto-immune and other illnesses
2. Physical stress such as surgery, poor nutrition, addiction, injury, and exhaustion
3. Emotional/psychological stress from relationships, finances, work or other unavoidable life situations
4. Continual and/or severe environmental stress from toxic chemicals and pollutants in the air, water, clothing or food

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Maintaining Sanity in Times of Stress: Stress Management Tips

Create a sense of control over the situation (or your response to it)

bike in a field by Flickr user Fire At WillA diminished sense of control or mastery over life is a risk factor for depression, and hopelessness can literally transform stress into depression.12 Increasing your sense of control can reduce this risk. If you are feeling stressed, find a way to exert at least some control over the situation. Sometimes just discussing a problem with a supportive friend (not ruminating to yourself, which is associated with depression) and strategizing possible solutions can bring a feeling of increased control over your life and what happens to you. Rarely is there a situation in which you cannot change some aspect or your perception of it, and even small changes can be empowering. Maybe you feel overwhelmed by everyone else’s demands on you and your time. Carving out even 15 minutes a day of self-time can help you feel more in charge of your life and reduce your risk of depression.

Be physically active

Exercise, especially strength training or cardiovascular activity (walking briskly, cycling, swimming, dancing), is a potent antidepressant, increasing endorphins—the “feel good” brain chemicals—and shown to be as effective as drugs and psychotherapy.8

Practice mindfulness

Mindfulness has proven to be beneficial with stress reduction, even in cancer patients who experience a high level of both physical and emotional stress. In mindfulness training, people are taught, with the help of meditative practice, to simply pay attention to what is present in the moment. This awareness is done without making judgments about the reasons for, relevance of, or effects of the experience. Immediately after the training, the participants experienced a better quality of life, more joy and less tension. A year later, participants not only maintained those effects, but also reported less depression, anger and mood disturbance, and more vigor.6

Avoid the use of alcohol

Alcohol can disrupt normal sleep patterns making it more difficult to cope with stress. Alcohol also disturbs blood sugar balance, sending it first higher and then allowing it to drop. The drop in blood sugar aggravates the mental and emotional effects of the alcohol and triggers a release of cortisol, putting yet another stress on already overworked adrenal glands. In addition, the metabolism of alcohol depletes B vitamins, crucial to the stress response.

Find a Friend

Loneliness may not be the first thing people think of when they think of a stressor, but loneliness increases the activity of the stress response system and is associated with depression, anxiety and cognitive decline.3, 11 Interventions to decrease loneliness have resulted in dramatic effects on depression reduction.

Support your stress response system

Nutrients particularly important for supporting the function of the adrenals and the stress response system include vitamin C, B6, zinc, magnesium and pantothenic acid. These all play a crucial part in supporting the health of the adrenal gland and in assisting a healthy cortisol response. Stress increases the need for these nutrients. Herbs such as eleutherococcus, ashwagandha and licorice help the body adapt to stress and maintain balance.

help sign by Flickr user LiminaMikeDon’t be afraid to ask for help

It takes strength to do it all alone, but it can take even more to ask for help. Depression, anxiety and other mental-emotional consequences of stress can be extremely painful and difficult to deal with—especially alone. Counselors, psychologists, and both medical and naturopathic physicians can offer options. Don’t be afraid to reach out.

About the Author

Dr. Lise NaugleDr. Lise Naugle is an associate of Dr. James L. Wilson. She assists healthcare professionals with clinical assessment and treatment protocols related to adrenal dysfunction and stress, and questions regarding the use of Doctor Wilson’s Original Formulations supplements. With eleven years in private practice and a focus on stress, adrenals, hormonal balance and mind-body connection, she offers both clinical astuteness and a wealth of practical knowledge. Dr. Naugle also maintains updated information about the latest scientific research on the hypothalamic-pituitary-adrenal axis function, endocrine balance and nutritional support for stress and develops educational materials about stress and health for clinicians and their patients.

References

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2. Brosschot JF, Benschop RJ, Godaert GL, Olff M, De Smet M, Heijnen CJ, Ballieux RE. Influence of life stress on immunological reactivity to mild psychological stress. Psychosom Med. 1994 May-Jun;56(3):216-24.
3. Chang EC, Hirsch JK, Sanna LJ, Jeglic EL, Fabian CG. A preliminary study of perfectionism and loneliness as predictors of depressive and anxious symptoms in Latinas: a top-down test of a model. J Couns Psychol. 2011 Jul;58(3):441-8.
4. Frodl T, O’Keane V. How does the brain deal with cumulative stress? A review with focus on developmental stress, HPA axis function and hippocampal structure in humans. Neurobiol Dis. 2012 Mar 9. [Epub ahead of print]
5. HSE. Health and Safety Statistics 2006/2007. http://www.hse.gov.uk/statistics/overall/hssh0607.pdf
6. Kieviet-Stijnen A, Visser A, Garssen B, Hudig W. Mindfulness-based stress reduction training for oncology patients: patients’ appraisal and changes in well-being. Patient Educ Couns. 2008 Sep;72(3):436-42. Epub 2008 Jul 25.
7. Krugers HJ, Karst H, Joels M. Interactions between noradrenaline and corticosteroids in the brain: from electrical activity to cognitive performance. Front Cell Neurosci. 2012;6:15. Epub 2012 Apr 9.
8. Martinsen, EW. The role of aerobic exercise in the treatment of depression. Stress Medicine 1987; 3(2): 93-100.
9. Mikolajczak M, Quoidbach J, Vanootighem V, Lambert F, Lahaye M, Fillée C, de Timary P. Cortisol awakening response (CAR)’s flexibility leads to larger and more consistent associations with psychological factors than CAR magnitude. Psychoneuroendocrinology. 2010 Jun;35(5):752-7. Epub 2009 Dec 2.
10. Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002 Sep 25;288(12):1447-50.
11. VanderWeele TJ, Hawkley LC, Thisted RA, Cacioppo JT. A marginal structural model analysis for loneliness: implications for intervention trials and clinical practice. J Consult Clin Psychol. 2011 Apr;79(2):225-35.
12. Weir K.F.; Jose P.E. A comparison of the response styles theory and the hopelessness theory of depression in preadolescents. Journal of Early Adolescence, v28 n3 (2008 08 01): 356-374

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